ESCRS - PO053 - Keratoplasty With Implantation Of A Polymeric 360° Ring And Edof Iol In A Patient With Advanced Keratoconus.

Keratoplasty With Implantation Of A Polymeric 360° Ring And Edof Iol In A Patient With Advanced Keratoconus.

Published 2025 - 43rd Congress of the ESCRS

Reference: PO053 | Type: Case Report | DOI: 10.82333/srgw-8420

Authors: Valeriia Suchkova* 1 , Maryam Muradova 1 , Svetlana Izmaylova 1 , Sergey Borzenok 2 , Werner Bernau 3

1Anterior Segment Transplant and Optical Reconstructive Surgery,S. Fyodorov Eye Microsurgery Federal State Institution,Moscow,Russian Federation, 2Eye bank,S. Fyodorov Eye Microsurgery Federal State Institution,Moscow,Russian Federation, 3Ziemer ophthalmology,Port,Switzerland

Purpose

To present the clinical outcome of a patient after previous femtosecond penetrating keratoplasty with polymer ring implantation, which enabled subsequent femtosecond cataract phacoemulsification with toric EDOF IOL implantation, fully eliminating residual astigmatism.

Setting

The study was conducted at Fedorov Eye Microsurgery Institution.

Report of case

A 25-year-old female patient was diagnosed with advanced keratoconus and early-stage cataract in the right eye.

     •       2020 – Visual acuity: 0.05 D, uncorrectable; AveK: 61.8 D.

     •       2021 – Underwent femtosecond penetrating keratoplasty with polymer ring implantation based on a customized laser algorithm (ring diameter: 8.5 mm; donor cutting pattern: “mushroom” 8.0/7.5 mm; recipient: 7.5/7.0 mm, with lamellar dissection and tunnel formation for a 9.2 mm ring).

     •       2022 – Suture removal. Six months postoperatively: visual acuity 0.3; sph -3.0 cyl -3.5 ax 30 = 0.4; AveK: 48.0 D.

     •       2023 – Underwent femtosecond cataract phacoemulsification with EDOF toric IOL implantation. The IOL power was calculated using three different formulas (Barrett Toric Calculator, Alcon Online Toric IOL Calculator, KANE Formula).

     •       2023 (6 months postoperatively) – Uncorrected distance visual acuity (UDVA, 5 m): 0.8 D; intermediate (66 cm): 0.7 D; near (33 cm): 0.6 D. Distance corrected visual acuity (5 m) with sph -0.5: 0.9 D. Subjective visual function was assessed using the Visual Function-14 questionnaire, scoring 95%, indicating high patient satisfaction.

Conclusion/Take home message

The results demonstrate the predictability and effectiveness of EDOF IOLs in patients with corneal pathology. However, considering the limitation of toric EDOF IOLs to correcting up to 4 D of corneal astigmatism, preventing ametropia during corneal surgery is crucial. Implanting a polymer ring during femtosecond penetrating keratoplasty enables keratometric values that allow complete astigmatism correction through toric EDOF IOL implantation, providing functional vision at multiple distances without spectacles especially for young people.